食管胃结合部癌和手术.pptVIP

Transthoracic vs transhiatal surgery for cancer of theesophagogastric junction * * distal esophageal adenocarcinomas (AEGⅠ) true cardia carcinomas (AEG Ⅱ) subcardiac gastric cancers (AEG Ⅲ). * SiewertⅠ型主要反映出来的是食管下段的病变，故以据病变上缘5-10厘米的部分食管和距病变下缘5厘米的近端胃行切除术，手术入路以经右或左开胸进行为宜； SiewertⅡ型距病变上缘5厘米的食管下段切除，下缘可行近端胃大部切除或全胃切除术，手术入路以腹-胸两切口或胸腹联合切口为宜； SiewertⅢ型则为全胃切除和距病变上缘5厘米的食管下段切除术，手术操作主要在腹部，是否需要做全胃切除尚存有争议，特别是早期病变。对于病变局限于黏膜或黏膜下，并且无淋巴结转移的证据，可考虑行近端胃切除术而取代全胃切除术，但其缺点经常造成胃食管返流以及不同程度的食管炎。 * * surgical time (A) blood loss (B), * hospital stay time (C) hospital deaths (D) * randomized controlled trials (A) non-randomized controlled trials (B) * anastomotic leak (A) * pulmonary complications (B) cardiovascular complications (C) * A: All Siewert types B: Siewert Ⅰ * C: Siewert Ⅱ; D: Siewert Ⅲ * CONCLUSION The results indicated a shorter hospital stay, lower 30-d hospital mortality and decreased pulmonary complications with the transhiatal approach compared with the transthoracic approach. Moreover, a potential survival benefit was achieved for type Ⅲ tumors using the transhiatal approach. * * * Conclusion there were no significant differences of survival rate, postoperative morbidity and mortality between transthoracic resection group and non-transthoracic resection group. * Questions Transthoracic : left thoracic, right thoracic, thoracoabdominal approaches; The optimum extent of lymph node resection is still controversial; OS:recommend the transthoracic approach as the preferred option for type I tumors and the transhiatal approach for type Ⅱ and Ⅲ tumors; * THANKS! *